Provider Demographics
NPI:1518097666
Name:SHEEHAN, MARITZA (OTR)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:701 W FRONT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2287
Mailing Address - Country:US
Mailing Address - Phone:231-935-0800
Mailing Address - Fax:231-935-0808
Practice Address - Street 1:701 W FRONT ST STE 100
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-0800
Practice Address - Fax:231-935-0808
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0119004707225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5535OtherNORTH CAROLINA LICENSE
VAC05501OtherMEDICARE GROUP
VA0119004707OtherVIRGINIA LICENSE